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Vol. 75, No. 2, 2013
Issue release date: February 2013
Gynecol Obstet Invest 2013;75:101-108
(DOI:10.1159/000345059)

Intrapartum Heart Rate Ambiguity: A Comparison of Cardiotocogram and Abdominal Fetal Electrocardiogram with Maternal Electrocardiogram

Reinhard J. · Hayes-Gill B.R. · Schiermeier S. · Hatzmann H. · Heinrich T.M. · Louwen F.
aDepartment of Obstetrics and Gynaecology, Faculty of Medicine, Johann Wolfgang Goethe University Frankfurt am Main, Frankfurt am Main, Germany; bSchool of Electrical and Electronic Engineering, University of Nottingham, University Park, Nottingham, UK; cObstetrics and Gynaecology, Faculty of Medicine, Marien Hospital Witten, University Witten/Herdecke, Teaching Hospital of the Ruhr University Bochum, Witten, Germany

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Abstract

Objective/Aims: To investigate the presence of signal ambiguity of intrapartum fetal heart rate (FHR) monitoring during delivery by comparing simultaneous cardiotocogram (CTG), abdominal fetal electrocardiogram (ECG) with continuous maternal ECG. Methods: A total of 144 simultaneous CTG (Corometrics© 250 series), abdominal fetal ECG (Monica -AN24™) and maternal ECG (Monica AN24™) recordings were evaluated. Main Outcome Measures: When the FHR is within 5 bpm of the maternal heart rate (MHR) acquired from the ECG, it is classified as ‘MHR/FHR ambiguity'. Statistical analyses were performed with Fisher's exact test and the Wilcoxon signed-rank test. Results: Comparison of abdominal fetal ECG against CTG demonstrates significantly less ‘MHR/FHR ambiguity' in both the first stage (mean 0.70 vs. 1.22%, p < 0.001) and second stage of labour (mean 3.30 vs. 6.20%, p < 0.001). Conclusion: Intrapartum FHR monitoring in daily practice via the CTG modality provides significantly more ‘MHR/FHR ambiguity' than abdominal fetal ECG, which also provides additional information on the MHR.



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References

  1. Mosler KH: Dauerüberwachung der fetalen Herzaktion unter der Geburt mittels Ultraschall. Experientia 1969;25:222.
  2. Neilson DR, Freeman RK, Mangan S: Signal ambiguity resulting in unexpected outcome with external fetal heart rate monitoring. Am J Obstet Gynecol 2008:717-724.
  3. Dawes GS: Numerical analysis of the human fetal heart rate: the quality of ultrasound records. Am J Obstet Gynecol 1981;141:43-52.

    External Resources

  4. Spencer JA, Belcher R, Dawes GS: The influence of signal loss on the comparison between computer analyses of the fetal heart rate in labour using pulsed Doppler ultrasound (with autocorrelation) and simultaneous scalp electrocardiogram. Eur J Obstet Gynecol Reprod Biol 1987;25:29-34.
  5. US Food and Drug Administration: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm181503.htm September 2009.
  6. Amer-Wahlin I, Hellsten C, Norén H, et al: Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial. Lancet 2001;358:534-538.
  7. Strachan BK, van Wijngaarden WJ, Sahota D, Chang A, James DK: Cardiotocography only versus cardiotocography plus PR-interval analysis in intrapartum surveillance: a randomised, multicentre trial. Lancet 2000;355:456-459.
  8. Strachan BK, Sahota DS, van Wijngaarden WJ, James DK, Chang AMZ: Computerised analysis of the fetal heart rate and relation to academia at delivery. Br J Obstet Gynaecol 2001;108:848-852.
  9. Salamalekis E, Vitoratos N, Loghis C, Panayotopoulos N, Kassanos D, Creatsas G: Evaluation of fetal heart rate patterns during the second stage of labor through fetal oximetry. Gynecol Obstet Invest 1999;48:151-154.
  10. Schiermeier S, Westhof G, Leven A, Hatz-mann H, Reinhard J: Intra- and interobserver variability of intapartum cardiotocography: a mulitcenter study comparing the FIGO classification with computer analysis software. Gynecol Obstet Invest 2011;72:169-173.
  11. Shewa A, Hacker TW, Nuovo J: Interpretation of the electronic fetal heart rate during labour. Am Family Phys 1999;59:2507-2512.

    External Resources

  12. Van Lierde M, de Muylder X, Thomas K: Fetal heart rate in the second stage of labour method of interpretation and parameters of the new-born. Gynecol Obstet Invest 1979;10:119-126.
  13. Schiermeier S, Hatzmann H, Reinhard J: Die Wertigkeit der computergestützten CTG-Analyse in den letzten 70 Minuten vor der Entbindung. Z Geburtshilfe Neonatol 2008;212:189-193.

    External Resources

  14. Schiermeier S, Pildner von Steinburg S, Thieme A, Reinhard J, Daumer M, Scholz M, Hatzmann W, Schneider KTM: Sensitivity and specificity of intrapartum computerised FIGO criteria for cardiotocography and fetal scalp pH during labour: multi-centre, observational study. BJOG 2008;115:1557-1563.
  15. Schiermeier S, Westhof G, Daumer M, Scholz M, Hatzmann W: Die Kurzzeitvariation der fetalen Herzfrequenz und der FIGO-CTG-Score. Erste Erfahrungen in der Kombination dieser Überwachungsparameter. Geburtshilfe Frauenheilk 2006;66:752-755.

    External Resources

  16. Parer JT, King T: Fetal heart rate monitoring: is it salvageable? Am J Obstet Gynecol 2000;182:982-987.
  17. Di Lieto A, Giani U, Campanile M, de Falco M, Scaramellino M, Papa R: Conventional and computerized antepartum telecardiotocography. Gynecol Obstet Invest 2003;55:37-40.
  18. Amer-Wahlin I, Marsai K: ST analysis of fetal electrocardiography in labor. Semin Fetal Neonatal Med 2011;16:29-35.
  19. Leathermann J, Parchman ML, Lawler FH: Infection of fetal scalp electrode monitoring sites. Am Fam Physician 1992;45:579-582.

    External Resources

  20. Reinhard J, Hatzmann H: Schiermeier S: -Fetales Elektrokardiogramm (EKG) als -Alternative der Doppler-Kardiotokografie (CTG) zur antepartualen Überwachung des Feten - erste Ergebnisse. Z Geburtshilfe Neonatol 2008;212:226-229.
  21. Reinhard J, Hayes-Gill BR, Yi Q, Hatzmann H, Schiermeier S: Signalqualität der nicht-invasiven fetalen Echokardiographie (EKG) unter der Geburt. Geburtsh Frauenheilk 2009;69:703-706.
  22. Reinhard J, Hayes-Gill BR, Yi Q, Hatzmann H, Schiermeier S: The equivalence of non-invasive foetal electrocardiogram (fECG) to Doppler cardiotocogram ultrasound during the first stage of labour. J Perinat Med 2010;38:179-85.
  23. Nageotte MP: Avoiding five common mistakes in FHR monitoring. Contemp Obstet Gynecol 2007;52:50-55.
  24. Bakker PCAM, Colenbrander GJ, Verstraeten AA, Van Geijn HP: The quality of intrapartum fetal heart rate monitoring. Eur J Obstet Gynecol Reprod Biol 2004;116:22-27.
  25. Ingemarsson I, Ingemarsson E, Spencer JAD: Technical aspects of fetal heart rate monitoring; in Fetal Heart Rate Monitoring a Practical Guide. Oxford, Oxford University Press, 1993, pp 12-26.
  26. Clinical Effectiveness Support Unit: The Use of Electronic Fetal Monitoring. The Use of Cardiotocography in Intrapartum Fetal Surveillance. Evidence-Based Clinical Guideline No. 8. London, RCOG Press, 2001.


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